合理化老年综合评估筛查轻度认知障碍并多维度病情分析

背景　认知功能是影响人们日常生活功能和生活质量的重要因素,人在衰老过程中,会出现认知功能下降,发生轻度认知障碍（MCI）,甚至痴呆。通过合理化老年综合评估（CGA）,筛查MCI,多维度分析病情,利于及时治疗、减缓疾病进展,减少痴呆。目的　探讨合理化CGA筛查MCI情况,并多维度分析病情。方法　选取2015年11月-2016年5月于成都市第五人民医院住院的年龄>60岁患者225例,根据是否符合《2018中国痴呆与认知障碍诊治指南（五）：轻度认知障碍的诊断与治疗》中MCI的诊断标准将研究对象分为认知功能正常组65例、MCI组108例（另52例不排除痴呆可能,未纳入）。收集患者基本资料,包含性别、年龄、文化程度、吸烟量、饮酒量。对患者进行老年综合相关量表评估,评估工具包含老年抑郁量表（GDS）、老年焦虑量表（GAI）、微型营养评定量表（MNA）、日常生活功能指数评定量表（ADL）〔包含躯体生活自理量表（PSMS）、工具性日常生活活动能力量表（IADL）〕、衰弱筛查量表（FRAIL）、Berg平衡量表（BBS）、跌倒危险因子评估表、家庭关怀度指数测评表（APGAR）、匹兹堡睡眠质量指数量表（PSQI）、生活质量评价量表（SF-36）。分析患者简易精神状态量表（MMSE）得分与基本资料的相关性,比较两组老年综合相关量表得分。结果　多元线性回归分析结果显示,性别、年龄、文化程度、吸烟量、饮酒量与认知功能无直线相关关系（P>0.05）。MCI组MNA得分、BBS得分低于认知功能正常组,ADL、IADL、FRAIL得分高于认知功能正常组（P<0.05）。结论　60岁上老年患者应进行合理化CGA,筛查MCI者,并多维度分析病情,识别可逆因素,减少可逆因素,帮助MCI转化为正常认知功能,减少痴呆发生。

Rational Comprehensive Geriatric Assessment Screening for Mild Cognitive Impairment and Multidimensional Analysis Conditions

Background　Cognitive function is an important factor affecting people's function and quality of life.In the process of aging,cognitive function will decline.Some people may have mild cognitive impairment（MCI）,even dementia.Rationalizing Comprehensive Geriatric Assessment （CGA）,screening MCI and multidimensional analysis of the disease are conducive to treat the disease timely,slow down the progress of the disease and reduce dementia.Objective　To take rational comprehensive geriatric assessment screening for mild cognitive impairment,and multidimensional analysis condition.Methods　We enrolled 225 inpatients aged >60 years in Chengdu Fifth People's Hospital from November 2015 to May 2016.According to 2018 Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment in China （V）：Diagnosis and Treatment of Mild Cognitive Impairment,the study subjects were divided into 65 cases of normal cognitive function group and 108 cases of MCI group （the other 52 cases did not exclude the possibility of dementia and were not included）．The basic data of patients were collected,including sex,age,educational level,smoking and alcohol consumption．They were surveyed by a suit of scales of comprehensive geriatric assessment,including Geriatric Depression Scale（GDS）,Geriatric Anxiety Inventory（GAI）,Mini Nutrition Assessment（MNA）,Activities of Daily Living（ADL）〔including Physical Self-maintenance Scale（PSMS）Instrumental Activities of Daily Living（IADL）〕,Frail Scale（FRAIL）,Berg Balance Scale（BBS）,Fall Risk Assessment,Family APGAR Index （APGAR）,Pittsburgh Sleep Quality Index（PSQI）,and the Short-Form Health Survey Questionnaire（SF-36）．The correlation between the scores of Mini-Mental State Exam（MMSE） and the basic data was analyzed and comprehensive geriatric assessment scales were compared between the two groups.Results　Multipe linear regression analysis showed that there was no line correlation between gender,age,educational level,daily smoking,daily drinking and cognitive function（P>0.05）．The scores of MNA and Berg balance scale in MCI group were lower than those in normal cognitive function group,while the scores of ADL,IADL and FRAIL in MCI group were higher than those in normal cognitive function group（P<0.05）．Conclusion　Patients over 60 years should take rational CGA,screen MCI,and multidimensionally analyse the condition,identify and reduce reversible factors,help MCI transform into normal cognitive function,and reduce the incidence of dementia.